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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153801387
Report Date: 01/03/2024
Date Signed: 01/04/2024 08:19:13 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/27/2023 and conducted by Evaluator Barbara Beneroso
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20231027085029
FACILITY NAME:GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
153801387
ADMINISTRATOR:ARNECKE, KRISTENFACILITY TYPE:
830
ADDRESS:329 SOUTH MILL STREETTELEPHONE:
(661) 823-7740
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY:10CENSUS: 5DATE:
01/03/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Madisann ParksTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff refuses to feed daycare child.
INVESTIGATION FINDINGS:
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On 01/03/2024, Licensing Program Analyst (LPA) Beneroso conducted an unannounced visit at the facility to deliver complaint investigation findings. Upon arrival, LPA was met by Director Madisann Parks who guided LPA on a tour of the facility. LPA observed 5 children in care with 4 staff providing care and supervision.
The investigation consisted of interviews with staff, children's parents, review of facility roster and other pertaining documents related to the complaint investigation. Documentation reviewed and confidential interviews conducted disclosed that on or about September 2023, Child #1 was not fed during its normal feeding schedule as directed by the family in the "Infant Needs and Service Plan" form. The investigation concluded that Staff #1 did not feed the child due to the parent/guardian being on their way to the facility to pick up the child, exceeding the stipulated time in between feedings of 2 hours to 2 1/2 hours.

Based on information obtained, observations, interviews conducted and relevant information received, this allegation is deemed SUBSTANTIATED. The facility was cited one Type B Citation in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. (See LIC 9099-D for cited deficiency). A substantiated finding means that the allegation is valid because the preponderance of the evidence standard has been met.

Exit Interview was conducted and A copy of this report, Notice of Site visit, and Appeal Rights were discussed and left with licensee Rennie at the facility.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/27/2023 and conducted by Evaluator Barbara Beneroso
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20231027085029

FACILITY NAME:GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
153801387
ADMINISTRATOR:ARNECKE, KRISTENFACILITY TYPE:
830
ADDRESS:329 SOUTH MILL STREETTELEPHONE:
(661) 823-7740
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY:10CENSUS: 5DATE:
01/03/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Madisann ParksTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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2
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5
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9
Staff left daycare child in soiled diapers resulting in a rash.
INVESTIGATION FINDINGS:
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On 01/23/24, LPA Beneroso amended report originally created on 01/03/2024 due to complaint allegation being mistankenly deemed Substantiated in the system.

On 01/03/2024, Licensing Program Analyst (LPA) Beneroso conducted an unannounced visit at the facility to deliver complaint investigation findings. Upon arrival, LPA was met by Director Madisann Parks who guided LPA on a tour of the facility. LPA observed 5 children in care with 4 staff providing care and supervision.

The investigation consisted of interviews with staff, children's parents, review of facility roster and other pertaining documents related to the complaint investigation. Documentation reviewed and confidential interviews conducted disclosed that on or about September and October it was alleged that Child 1 was left in a soiled diaper as staff was not meeting diaper changing needs. According to the diaper changing logs and interviews with relevant parties, it was revealed that staff was checking and changing diapers during the days made in the allegation for Child 1 and other children in care using diapers. Additionally, interviews with relevant parties did not corroborate the allegation that children diaper changing needs were not being met. After reviewing the relevant information obtained, there is not a preponderance of the evidence to support the allegation.The allegation is deemed Unsubstantiated

An exit interview was conducted, and a copy of this report was provided to Licensee Madisann Park salong with the Notice of Site Visit and Appeal Rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 12-CC-20231027085029
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801387
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2024
Section Cited
CCR
101427(c)
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101427 Infant Care Food Service (c )The infant shall be fed in accordance with the Needs and Service plan. This requirement is not met as evidenced by:
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Per facility representative, the Center will continue to communicate with the parents and update the feeding plan as necessary. A staff training will be completed. A copy of the staff training sign in sheet will be provided to the Department.
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Based on record review, C1s individual feeding plan indicated C1 was to be fed every two to two 1/2 hours. Per Interviews conducted, infant exceeded time of feeding stipulated in the Needs and Service Plan. This poses a potential Health, Safety or Personal Rights risk to the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3